Sleep Apnoea

You are currently browsing the archive for the Sleep Apnoea category.

An award-winning NHS service to help patients with diagnosis and management of obstructive sleep apnoea (OSA) is opening at Hampton Hill Medical Centre (TW12 1NY) on 12  September.

OSA is caused by an obstruction blocking the airway of the throat so that the air cannot reach the lungs, leaving the sufferer gasping for breath. Men are three times more likely to have the condition, which affects around 1.5 million adults in the UK. If left untreated, OSA can cause heart disease, hypertension, stroke and exacerbate diabetes.

Symptoms of OSA may include:

  • breath holding/struggling to breath at night (apnoea)
  • very loud snoring
  • daytime fatigue and drowsiness
  • short-term memory loss
  • multiple trips to urinate through the night
  • early morning headaches
  • loss of interest in sex

Richmond Clinical Commissioning Group (CCG) has commissioned a community based OSA service, which is available to people who have been referred by their GP. It is one of the first of its kind in the country and allows patients to be assessed and monitored in the comfort of their own home.

The service has been developed in partnership with consultant ear, nose and throat surgeons and Department of Health OSA advisors, Professor Ram Dhillon and Mr Michael Oko.

Dr Graham Lewis, local GP and chair of Richmond CCG, said: “For some people who snore, the cause will be OSA. It is a common, treatable condition, but many people don’t know they have it and require diagnosis. It is important to make an appointment to see your GP if you have any symptoms.”

The service allows many of the patients with suspected OSA or those with established OSA to be diagnosed and monitored in their own bed, without having to spend a night away from home.

Dr Lewis continues: “The good news is that we can help 80% of patients manage the condition at home, without the need for surgery. This could be anything from lifestyle changes to state-of-the-art technology which enables us to track the progress of a patient at the touch of a button.

“We are very pleased to be offering this innovative service for people living in the borough of Richmond who have suspected obstructive sleep apnoea.”


The Office for Health Economics and The British Lung Foundation have published a report this month which clearly demonstrates the cost of undiagnosed sleep apnoea to the NHS.

Despite the clear evidence of benefit and value for money, there is evidence from recent research estimating that about 85 per cent of OSA cases currently are undiagnosed and untreated in the UK.

Research found the following OSA prevalence in the UK:

1.5 million adults living with OSA
45 per cent have moderate and severe OSA: 667,000 people
55 per cent have mild OSA



Considering only direct benefits, the report estimates the NHS in the UK would be saving a total of £55 million and producing 40,000 QALYs annually if all people with moderate to severe OSA (45 per cent of the total OSA patient population) were diagnosed and treated with CPAP, relative to none being diagnosed and treated.

If everyone estimated to have moderate to severe OSA in the UK were treated, compared with the estimated current treatment level, the NHS would be saving £28 million pounds and producing 20,000 QALYs annually. Approximately 40,000 road accidents could be prevented.

In addition to direct health benefits to patients and costs/savings to the NHS, treating OSA produces wider economic benefits, including increased productivity due to reduced sleepiness at work, and also quality of life improvements for people close to OSA patients (their bed partners).

The evidence found in the literature demonstrates that OSA patients, the NHS and the wider society in the UK have not yet obtained all of the economic and health benefits that could be achieved. An increase in the rate of uptake of CPAP could double the savings to the NHS and the health benefits to patients compared to the current situation.

Tags: , , , ,

STAYING up late for a few nights to meet work deadlines may bring relief when the assignment is completed, but how will such an employee function at work the next day?

Tired employees are often in a foul mood. They cannot handle stress and may fly off the handle at the smallest offence. They are unable to think as clearly or imaginatively as others, and tasks are more challenging.

Researchers based at hospitals with sleep laboratories have charted the effects of a lack of sleep. Short-term effects include less healthy food choices, a higher likelihood of road accidents and being prone to infectious ailments. The person may be less gregarious and more emotional. Memory and focus suffer, and, most seriously, a recent study in the journal Sleep linked one night without sleep to a loss of brain tissue.

Long-term effects are more alarming: the risk of developing cancer may increase; obesity risk rises abruptly; the risk of having a stroke quadruples; people are more likely to develop heart disease or diabetes; and the sperm count in men decreases.

Another study shows that less than six hours of kip a night significantly increases mortality risk.

What can company directors and managers do to ensure employees function at their peak during the working day? Some have installed nap rooms or energy pods that allow workers to catch up on sleep.

Google, Procter & Gamble, Huffington Post and Nationwide Planning have incorporated napping into daily office life. Mike Karalewich, chief compliance officer of Nationwide Planning, swears by it, saying it “really allows me to approach the second half of the day with a lot more force”.

Nathaniel Hindman, a former editor and reporter at the Huffington Post, concurs: “Sleep makes us more productive, creative, less stressed and much healthier and happier.”

Irshaad Ebrahim, specialist neuropsychiatrist in sleep disorders at the Constantia Sleep Centre and the London Sleep Centre on Harley Street, says people don’t only need enough sleep, but enough “good sleep”. His “2-Q Rule of Sleep” is to seek both quality and quantity.

“The best measure of your sleep quality is how you feel when you wake up in the morning — if you are getting adequate quantity but still wake up unrefreshed, tired and feel sleepy during the daytime, you should book a sleep assessment at your nearest sleep centre,” he advises. “Common conditions that affect sleep quality are snoring, sleep apnoea, restless leg syndrome and medical conditions like cardiac disorders and diabetes.”

A University of California study found there are “short-sleepers”, who go to bed around midnight and wake each morning — between 4am and 5am — feeling completely refreshed.

Lead study author Ying-Hui Fu and her colleagues discovered a tiny mutation in the DEC2 gene that seemed present in “short-sleepers”, who function just as well on limited sleep as those who get eight hours.

According to Fu, “Sleep is vitally important. If you sleep well, you can avoid many diseases, even dementia.”

The brain performs repair work on its cells during sleep, removing toxins, restoring energy levels and laying down memories for future reference.

Fu says many people who thought they were short-sleepers volunteered for the study and discovered they were suffering from insomnia. “We wanted to focus on people who slept for just a few hours and still felt great. These individuals are all very energetic, very optimistic. It’s very common for them to feel they want to cram as much into life as they can, but we’re not sure how or whether this is related to their gene mutations.”

While Ebrahim believes that the decision by some corporates to enhance sleep health by installing nap rooms or pods is admirable, he says the focus should be on the reasons people need daytime naps.

Companies should instead tackle the underlying causes of the sleep debt — the amount of sleep a brain is deprived of and needs to repay. “Once we address the underlying causes, there may well be no need for sleep pods at work,” he says.

Source: BDLive


Continuous positive airway pressure is effective at treating sleep apnoea in older people, a new study has found. Previous studies have established the benefits of CPAP in middle-aged people with OSA, but until now there has been no research on whether the treatment is useful and cost-effective for older patients.

The new research found that CPAP reduces how sleepy patients feel in the daytime and reduces healthcare costs. The researchers say CPAP should be offered routinely to older patients with OSA, and more should be done to raise awareness of the condition.

The study, published today in Lancet Respiratory Medicine, involved 278 patients aged 65 or over at 14 NHS centres in the UK. It was led by researchers at Imperial College London and the Royal Infirmary of Edinburgh in collaboration with the Medical Research Council Clinical Trials Unit at UCL, and the Universities of Oxford and York. It was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

Around 20 per cent of the adult population experiences breathing problems during sleep. In four to five per cent of middle-aged people, these problems lead to sleepiness in the daytime, classified as obstructive sleep apnoea syndrome. The condition is thought to be more common in older people, but the true prevalence is unknown, in part because patients and their relatives may attribute their sleepiness to old age, or older people can compensate by napping. The disease is becoming more common because obesity is a major risk factor.

Professor Mary Morrell, co-principal investigator of the study from the National Heart and Lung Institute at Imperial College London, said: “Sleep apnoea can be hugely damaging to patients’ quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment. Many patients feel rejuvenated after using CPAP because they’re able to sleep much better and it may even improve their brain function.”

Patients with sleep apnoea sometimes stop breathing for 30 seconds or longer at night before they wake up and start breathing again. In these pauses, their blood oxygen levels fall.

“We think low oxygen levels at night might accelerate cognitive decline in old people, and studies have found that sleep apnoea causes changes in the grey matter in the brain. We’re currently researching whether treatment can prevent or reverse those changes,” said Professor Morrell.

Co-principal investigator Dr.Renata Riha, Consultant and Honorary Reader at the Royal Infirmary of Edinburgh, added that sleep medicine spans many disciplines and comprises an important area of research which deserves support and greater recognition by funding bodies, universities and public policy makers. “Sleep disorders, such as sleep apnoea, impact on a wide variety of chronic conditions, potentially leading to their development or worsening them, including diabetes, heart attacks, strokes and possibly even cancer. Successful treatment diminishes this risk but we still have a great deal of work to do in the area,” she said.

Source: Imperial College London

Tags: , , , , , ,

Half of hypertensive pregnant women who snore and one quarter of those who do not snore have unrecognized obstructive sleep apnea (OSA), suggesting such women should be tested for this condition. Findings from this cohort study were published online May 29 in BJOG.

OSA is associated with reduced nocturnal blood oxygen levels and other morbidity. The prevalence of OSA increases during pregnancy, affecting up to one third of women by the third trimester.

“We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies,” lead author Louise O’Brien, PhD, associate professor, Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, said in a news release. “Our findings show that a substantial proportion of hypertensive pregnant women have [OSA] and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes.”

The study goal was to examine the prevalence of OSA among women with and without hypertensive disorders of pregnancy followed-up at obstetric clinics at an academic medical center. Pregnant women who were normotensive and those with hypertensive disorders (chronic hypertension, gestational hypertension, or preeclampsia) completed a questionnaire regarding habitual snoring. They also underwent overnight ambulatory polysomnography to determine the presence and severity of OSA.

In what is the largest study to date on the association between the two conditions, researchers in Canada demonstrated a link between obstructive sleep apnoea (OSA) – a common breathing disorder that affects people during sleep – and the development of type 2 diabetes.

The team led by Dr Tetyana Kendzerska of the University of Toronto analysed data from 8,678 adults with suspected OSA and without diabetes at baseline who took part in a diagnostic sleep study between 1994 and 2010. All of the participants were tested for OSA and graded according to the severity of their sleep apnoea, based on the number of apnoeas (complete blockage of the upper airway) and hypopnoeas (partial blockage of airway) experienced per hour of sleep, and followed for development of diabetes.

During follow-up, 1,017 (11.7%) of the participants were diagnosed with type 2 diabetes. After adjusting for known risk factors for the disease, including age, sex, BMI, neck circumference and smoking at baseline, those classed as having severe OSA had a 30% greater risk of developing type 2 diabetes compared to those without OSA. Diabetes risk was also 23% higher for patients with mild or moderate OSA. In addition, Rapid eye movement sleep, lack of oxygen in the blood, and activation of the sympathetic nervous system, as indicated by a higher average heart rate during sleep, were linked to higher diabetes risk.

“After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes,” Dr Kendzerska said in a statement. “Our findings that prolonged oxygen desaturation, shorter sleep time and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes.”

The lead author added that the results “address some of the limitations of earlier studies on the connection between OSA and diabetes”, as their study involved a larger sample size and a longer median follow-up. The researchers did, however, acknowledge a few limitations to the study, including not being able to screen for family history of diabetes and ethnicity.

“The OSA-related predictors of increased diabetes risk that we found in our study may allow for early preventative interventions in these patients,” Dr. Kendzerska concluded.

Tags: , , , , , ,

Both men and women appear to have a greater risk of stroke if they suffer from obstructive sleep apnea, researchers found.

Through up to 14 years of follow-up, stroke risk increased along with the obstructive sleep apnea index to a similar extent in both men and women, according to Suzanne Bertisch, MD, instructor in medicine at Harvard Medical School/Beth Israel Deaconess Medical Center in Brookline, Mass.

The 5-year probability of having a stroke with the least severe obstructive sleep apnea index was 0.4% for women and 0.6% for men, while the probability in the highest quartile of obstructive sleep apnea severity was 1.2% for women and 1.8% for men, she reported at the American Thoracic Society meeting in San Diego.

At 10 years, the probability of having a stroke if you were in the lowest quartile of the sleep apnea index was 0.9% for women and 1% for men, while the probability of having a stroke in the highest quartile of the apnea index was 2.3% in women and 3.1% in men.

All results were adjusted for various confounders, including age, race, education level, smoking status, diabetes, hypertension, and body mass index, she said.

Tags: , , , , , ,

Sufferers of a common sleep-breathing disorder have diminished activity among neurons responsible for keeping heart rate low, reveals a new study published today [16 May] in The Journal of Physiology.

The research discovered that in obstructive sleep apnoea (OSA), neurons in the brainstem that control heart rate experience a blunting of their activity. The reduction of neuronal activity likely contributes to the increased heart rate, blood pressure and risk of adverse cardiovascular events that occur in patients with OSA.

OSA is a common cardiovascular disease, occurring in 24% of adult males and 9% of adult females, which causes repetitive interruptions of breathing during sleep. Lack of oxygen during these episodes brings the person to a lighter state of sleep or brief wakefulness to restore normal breathing. Cycles of interrupted breathing and arousal from sleep can occur as frequently as once per minute.

Dr David Mendelowitz, who led the study at The George Washington University USA, says:

“Lack of sleep leaves the mind and body tired, leading to poor mental and physical performance, and if untreated OSA increases a person’s risk of developing hypertension and irregular heartbeats. Therefore it is very important that we have discovered some of the underlying mechanisms that could injure the heart and other cardiovascular tissues.

“Our study shows that progression of blunted cardiovascular reflexes is accompanied, and likely maintained by, inhibition of neurons in the brainstem that protect the heart and normally maintain a low resting heart rate. This study would predict that patients who have OSA, and also take sleep medicines, might be at heightened risk for an exaggerated reduction of essential neuronal activity that protects the heart.”

The team explored these mechanisms in rats, by mimicking OSA for four weeks and studying the changes in blood pressure, heart rate, and synaptic activity in parasympathetic neurons that control heart rate.

Future work will need to build from this foundation and focus on finding targets to restore the usual cardio-protective function of these neurons to help reduce the risk of arrhythmias, elevated heart rate, and blood pressure that occur with this disease.

Tags: , , , , ,

People with sleep apnea, a common sleep disorder, may be at increased risk for the bone-thinning disease osteoporosis, especially women and older people, a new study suggests.

Sleep apnea causes repeated, brief interruptions in breathing during sleep. Untreated sleep apnea can increase a person’s risk of heart disease, heart attack and stroke.

“Ongoing sleep disruptions caused by obstructive sleep apnea can harm many of the body’s systems, including the skeletal system,” said study co-author Dr. Kai-Jen Tien, of Chi Mei Medical Center in Tainan, Taiwan.

“When sleep apnea periodically deprives the body of oxygen, it can weaken bones and raise the risk of osteoporosis,” Tien said. “The progressive condition can lead to bone fractures, increased medical costs, reduced quality of life and even death.”

For the study, published April 15 in the Journal of Clinical Endocrinology & Metabolism, researchers analyzed the medical records of nearly 1,400 people in Taiwan diagnosed with obstructive sleep apnea between 2000 and 2008. They compared them with more than 20,600 people who did not have the sleep disorder.

Over six years of follow-up, people with sleep apnea were 2.7 times more likely to be diagnosed with osteoporosis. The risk for the bone-thinning disease was highest among women and older people with sleep apnea, according to the study.

“As more and more people are diagnosed with obstructive sleep apnea worldwide, both patients and health care providers need to be aware of the heightened risk of developing other conditions,” Tien said in a journal news release. “We need to pay more attention to the relationship between sleep apnea and bone health so we can identify strategies to prevent osteoporosis.”

However, the study only noted an association between sleep apnea and osteoporosis. It does not prove that one causes the other.

Tags: , , , , ,

Sleep apnea is common in people with multiple sclerosis and may contribute to their fatigue, a new study shows. Fatigue is one of the most frequent and debilitating symptoms experienced by MS patients. The study included 195 people with MS who completed a sleep questionnaire and were assessed for daytime sleepiness, insomnia, fatigue severity and sleep apnea.

One-fifth of the patients had been diagnosed with sleep apnea and more than half were found to have an elevated risk for the condition. The researchers also found that sleep apnea risk was a significant predictor of fatigue severity.

MS is a chronic, frequently disabling disease that attacks the central nervous system, according to the National Multiple Sclerosis Society. Symptoms range widely, from mild signs such as numbness in the limbs to severe symptoms including paralysis or loss of vision.

The new findings suggest that sleep apnea may be a common but under-recognized contributor to fatigue in MS patients, and doctors should not hesitate to check these patients for sleep problems, study author Dr. Tiffany Braley, an assistant professor of neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers, said in an AASM news release.

“Obstructive sleep apnea is a chronic illness that can have a destructive impact on your health and quality of life,” and MS patients at high risk for sleep apnea should undergo a comprehensive sleep evaluation, academy president Dr. M. Safwan Badr said in the news release.

The study appears in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, an AASM publication. About 400,000 people in the United States have MS, according to the National Multiple Sclerosis Society. Up to 7 percent of men and 5 percent of women have sleep apnea, according to the AASM.

Tags: , , , , , , , , ,

« Older entries